Mirrored-self Misidentification Research Articles

Exploring the Neural Mechanisms of Mirrored-Self Misidentification in Alzheimer's Disease.

Alzheimer's disease (AD) is a complex neurodegenerative condition that causes a range of cognitive disturbances, including mirror-self misidentification syndrome (MSM), in which patients cannot recognize themselves in a mirror. However, the mechanism of action of MSM is not precisely known. This study aimed to explore the possible neural mechanisms of action of MSM in AD using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). This study included 48 AD patients, 13 in the MSM group and 35 in the non-MSM group. The permeability of the blood-brain barrier (BBB) was quantitatively monitored by measuring the transfer rate (Ktrans) of the contrast agent from the vasculature to the surrounding tissue using DCE-MRI. The concentration of contrast agents in different brain regions was measured, and the Patlak model was used to calculate Ktrans. Ktrans values were compared between the left and right cerebral hemispheres in different brain areas between the MSM and non-MSM groups. Additionally, the difference in Ktrans values between mild and severe MSM was assessed. Logistic regression analysis was used to examine the risk factors for MSM. The Mann‒Whitney U test was used to compare two groups and revealed elevated Ktrans values in the left thalamus, left putamen, left globus pallidus, left corona radiata, and right caudate in the MSM group (p<0.05). Logistic regression analysis revealed that increased Ktrans values in the left putamen (OR=1.53, 95% CI=1.04, 2.26) and left globus pallidus (OR=1.54, 95% CI=1.02, 2.31) may be risk factors for MSM. After dividing MSM patients into mild and moderate-severe groups, the Ktrans values of the thalamus in the moderate-severe group were greater than those in the mild group (p<0.05). Our study revealed the relationship between BBB permeability and MSM in AD. MSM is associated with BBB breakdown in the left putamen and globus pallidus. The left putamen and globus pallidus may function in mirror self-recognition. Higher BBB permeability in the thalamus may reflect the severity of AD in MSM.

Abstract- Poster

Introduction:Delusion of misidentifications are characterized by delusional belief that familiar person, objects, or self have been replaced or transformed. There are four common types like Capgras syndrome, Fregoli syndrome, Syndrome of subjective doubles and syndrome of intermetamorphosis. Another type of delusion of misidentification is mirrored self- misidentification, where the delusional belief is that one’s reflection in the mirror is misidentified as a stranger.Case report:A 83 years old male patient Mr. X, graduate, married, retired from his job, belonging to middle socio-economic status, hailing from urban background was accompanied to the OPD by his daughter. Informant had complaints of suspiciousness, abusing family members, abnormal behavior, and memory impairment since 6 months. Patient started suspecting that there is stranger whenever he looked into the mirrored or any other reflecting surfaces. Later he started suspecting that stranger was coming to meet his wife. Apart from this he also had memory disturbances. All the investigations were normal and he was started on Tab. Quetiapine -25mg and Tab. Donepezil -5mg.Discussion:The ability to recognize oneself in the mirror has a potential way of testing self-awareness, but it is not clearly known how the brain does it. Mirrored-self misidentification has rarely been described in the literature. Most of the reported patients have global dementia of the Alzheimer type, making it difficult to infer the anatomical basis of this disorder.Conclusion:The loss of the ability to recognize oneself in the mirror is evidence of a fundamental change in the sense of self and this may cause interpersonal problems as well. Managing such cases may be difficult and challenging.

Mirror self recognition as a product of forward models; implications for delusions of body image and visual neglect

Forward models allow individuals to learn to predict the sensory consequences of their own behavior. Social forward models have been proposed as an extension of forward models, allowing individuals to learn to predict the response of another to the individual's own behavior. This article proposes similarly that an individual who treats their reflection as another may learn to predict the behavior of their reflection, offering a new perspective on mirror self-recognition and a potential framework through which to investigate visual delusions. Specifically this article investigates this framework by considering four body image delusions; mirrored-self misidentification, body integrity disorder (BID), phantom limbs, and gender dysphoria, and two delusions associated with visual neglect; somatoparaphrenia and mirror agnosia.

Hypnotic models of mirrored-self misidentification delusion: A review and an evaluation.

Hypnotic models of mirrored-self misidentification delusion: A review and an evaluation.

Using hypnosis to disrupt face processing: mirrored-self misidentification delusion and different visual media.

Mirrored-self misidentification delusion is the belief that one’s reflection in the mirror is not oneself. This experiment used hypnotic suggestion to impair normal face processing in healthy participants and recreate key aspects of the delusion in the laboratory. From a pool of 439 participants, 22 high hypnotisable participants (“highs”) and 20 low hypnotisable participants were selected on the basis of their extreme scores on two separately administered measures of hypnotisability. These participants received a hypnotic induction and a suggestion for either impaired (i) self-face recognition or (ii) impaired recognition of all faces. Participants were tested on their ability to recognize themselves in a mirror and other visual media – including a photograph, live video, and handheld mirror – and their ability to recognize other people, including the experimenter and famous faces. Both suggestions produced impaired self-face recognition and recreated key aspects of the delusion in highs. However, only the suggestion for impaired other-face recognition disrupted recognition of other faces, albeit in a minority of highs. The findings confirm that hypnotic suggestion can disrupt face processing and recreate features of mirrored-self misidentification. The variability seen in participants’ responses also corresponds to the heterogeneity seen in clinical patients. An important direction for future research will be to examine sources of this variability within both clinical patients and the hypnotic model.

Delusions in the hypnosis laboratory: Modeling different pathways to mirrored-self misidentification.

Mirrored-self misidentification is the delusional belief that one’s reflection in the mirror is a stranger. According to an influential theory, the content of this delusion can arise from either impaired face processing (and hence a difficulty in recognizing oneself) or mirror agnosia (an inability to use mirror knowledge when interacting with mirrors). We used hypnotic suggestions to model these two deficits and recreate features of the delusion. Sixty high-hypnotizable participants received a hypnotic induction and a suggestion for either the fully-formed delusion, impaired face processing, or mirror agnosia. All suggestions successfully recreated features of the mirrored-self misidentification delusion in the majority of participants. However, only participants given the mirror-agnosia suggestion, and not the impaired-face-processing suggestion, showed an impaired ability to use and define mirrors. These findings show that we can hypnotically recreate the delusion from its theorized components and illustrate the value of using hypnotic suggestions to model psychopathology.

A laboratory analogue of mirrored-self misidentification delusion: The role of hypnosis, suggestion, and demand characteristics

Mirrored-self misidentification is the delusional belief that one's own reflection in the mirror is a stranger. In two experiments, we tested the ability of hypnotic suggestion to model this condition. In Experiment 1, we compared two suggestions based on either the delusion's surface features (seeing a stranger in the mirror) or underlying processes (impaired face processing). Fifty-two high hypnotisable participants received one of these suggestions either with hypnosis or without in a wake control. In Experiment 2, we examined the extent to which social cues and role-playing could account for participants' behaviour by comparing the responses of 14 hypnotised participants to the suggestion for impaired face processing (reals) with those of 14 nonhypnotised participants instructed to fake their responses (simulators). Overall, results from both experiments confirm that we can use hypnotic suggestion to produce a compelling analogue of mirrored-self misidentification that cannot simply be attributed to social cues or role-playing.

Hypnotic analogues of delusions: The role of delusion proneness and schizotypy

There is compelling evidence that hypnotic suggestions can be used to model clinical delusions in the laboratory. In two studies, we investigated the role that personality factors, delusion proneness and schizotypy, played in shaping such hypnotic models. In the first study, 398 participants were screened on measures of hypnotisability, delusion proneness, and schizotypy. Hypnotisability correlated with both delusion proneness and the cognitive–perceptual subscale of schizotypy. In the second study, 22 high and 20 low hypnotisable participants were given suggestions to model two content specific delusions: Frégoli (the belief that strangers are actually known people in disguise) and mirrored-self misidentification (the belief that one’s reflection in the mirror is a stranger). Whereas high delusion proneness predicted which high hypnotisable participants responded to the suggestion for Frégoli delusion, hypnotisability scores predicted which high hypnotisable participants responded to the suggestion for mirrored-self misidentification. No lows responded to either suggestion. We discuss the implications of these findings for hypnotic models of delusions.

Delusional misidentification syndrome and other unusual delusions in advanced Parkinson's disease

BackgroundUnusual delusional syndromes are rare protean diseases with speculative etiopathogenic mechanisms. MethodsSeven consecutive patients with advanced PD were evaluated over a 15-year period at the Movement Disorders Unit in the Neurology Service, Hospital de Clínicas, Federal University of Paraná, and the Paraná State Parkinson's Patients Association. ResultsWe describe advanced Parkinson's disease patients presenting with unusual delusional syndromes, including cases of Ekbom, Othello, Capgras' and Diogenes syndromes, reduplicative paramnesia and mirrored-self misidentification. ConclusionThere are a few isolated reports of unusual neuropsychiatric disorders in patients with PD. We believe that these syndromes associated with advanced PD in elderly patients presenting with cognitive impairment and polypharmacy are probably often underestimated. Neurologists should be aware for these rare and treatable conditions.

Mirrored-self misidentification in the hypnosis laboratory: Recreating the delusion from its component factors

Introduction. Mirrored-self misidentification is the delusional belief that one's reflection in the mirror is a stranger. According to Langdon and Coltheart's (2000) “two-factor” theory of monothematic delusions, the delusion can arise from deficits in face processing (Factor 1) and belief evaluation (Factor 2). This study gave participants separate hypnotic suggestions for these two factors to create a hypnotic analogue of the delusion. Method. Forty-six high hypnotisable participants received a hypnotic suggestion for either Factor 1 alone or for Factors 1 and 2, either with hypnosis (hypnosis condition) or without (wake condition). Participants were asked to look into a mirror and to describe what they saw. Participants who reported seeing a stranger in the mirror also received a series of challenges. Results. Overall, 70% of participants in the hypnosis condition passed the delusion; only 22% of participants in the wake condition passed. Importantly, in hypnosis, the Factor 1 alone suggestion was just as effective in creating the delusion as the combined Factor 1 and Factor 2 suggestion. Conclusion. These results suggest that hypnotic suggestion can recreate the mirrored-self misidentification delusion from its component factors. Notably, the hypnotic context, itself known to disrupt belief evaluation, can act as Factor 2.

Mirror agnosia and the mirrored-self misidentification delusion: A hypnotic analogue

Introduction. Mirrored-self misidentification is the delusional belief that one's reflection in the mirror is a stranger. Current theories suggest that one pathway to the delusion is mirror agnosia (a deficit in which patients are unable to use mirror knowledge when interacting with mirrors). This study examined whether a hypnotic suggestion for mirror agnosia can recreate features of the delusion. Method. Ten high hypnotisable participants were given either a suggestion to not understand mirrors or to see the mirror as a window. Participants were asked to look into a mirror and describe what they saw. Participants were tested on their understanding of mirrors and received a series of challenges. Participants then received a detailed postexperimental inquiry. Results. Three of five participants given the suggestion to not understand mirrors reported seeing a stranger and maintained this belief when challenged. These participants also showed signs of mirror agnosia. No participants given the suggestion to see a window reported seeing a stranger. Conclusion. Results indicate that a hypnotic suggestion for mirror agnosia can be used to recreate the mirrored-self misidentification delusion. Factors influencing the effectiveness of hypnotic analogues of psychopathology, such as participants’ expectations and interpretations, are discussed.

A Stranger in the Looking Glass: Developing and Challenging a Hypnotic Mirrored-Self Misidentification Delusion

This article describes a study that used hypnosis to temporarily re-create mirrored-self misidentification, which is the delusional belief that the person one sees in the mirror is a stranger. Following a hypnotic suggestion to see a stranger in the mirror, high hypnotizable subjects described seeing a stranger with physical characteristics different to their own. Whereas subjects' beliefs about seeing a stranger were clearly false, they had no difficulty generating sensible reasons to explain the stranger's presence. The authors tested the resilience of this belief with clinically inspired challenges. Although visual challenges (e.g., the hypnotist appearing in the mirror alongside the subject) were most likely to breach the delusion, some subjects maintained the delusion across all challenges. Findings are discussed in light of the dominant theory of delusions and highlight the advantages of using hypnosis to explore delusional beliefs.

Mirrored-self misidentification in a patient without dementia: evidence for right hemispheric and bifrontal damage

Mirrored-self misidentification, often referred as the ‘mirror sign’, is a delusion characterized by the inability to recognize one's own reflected image, often associated with the intact capacity to recognize others in the mirror. It has been described mainly in moderate or severe dementia, especially Alzheimer's disease. In the few reported cases without global cognitive impairment, right hemispheric and frontal dysfunctions have been described. We report a 90-year-old man with abrupt onset of the mirror sign after a minor right hemispheric ischemic stroke. Neuropsychological testing revealed preserved cognitive capacities, except for mild to moderate impairment of visuospatial skills, suggesting right hemisphere dysfunction. Neuroimaging showed a small right dorsolateral frontal infarct, and bifrontal encephalomalacia, consistent with a past history of head trauma. Scattered ischemic white matter lesions in posterior periventricular regions were also seen. It seems that the mirror sign is a multifactorial phenomenon that usually requires right hemispheric dysfunction (perceptual abnormalities, loss of familiarity) and frontal damage (loss of judgement and inability to correct wrong beliefs). The right frontal dorsolateral prefrontal cortex seems to have a crucial role in self-recognition.

Hypnotic illusions and clinical delusions: Hypnosis as a research method

Introduction. Hypnosis is not only intrinsically interesting, but it can be used instrumentally as a powerful tool to investigate phenomena outside its immediate domain. In focusing on instrumental hypnosis research, we first sketch the many contributions of hypnosis across a range of areas in experimental psychopathology. In particular, we summarise the historical and more recent uses of hypnosis to create and explore clinically relevant, temporary delusions. Methods. We then describe in detail the steps that hypnosis researchers take in constructing a hypnotic paradigm to map the features and processes shared by clinical and hypnotic delusions, as well as their impact on information processing (including autobiographical memory). We illustrate with hypnotic versions of mirrored-self misidentification, somatoparaphrenia, alien control, and identity delusions. Results. Finding indicate that hypnotic analogues can produce compelling delusions with features that are strikingly similar to their clinical counterparts. These similarities encompass phenomenological features of delusions, delusional resistance to challenge, and autobiographical memory during delusions. Conclusions. We recognise important methodological issues and limitations of such hypnotic analogues, including: indexing response (behaviour vs. experience), alternative explanations (e.g., social compliance), the need for converging data, the need for close and continuing dialogue between the clinic and the laboratory, and generalisability of the findings.

Developing hypnotic analogues of clinical delusions: Mirrored-self misidentification

Introduction. Despite current research interest in delusional beliefs, there are no viable models for studying delusions in the laboratory. However, hypnosis offers a technique for creating transient delusions that are resistant to challenge. The aim of this study was to develop an hypnotic analogue of one important delusion, mirrored-self misidentification. Methods. Twelve high hypnotisable participants received an hypnotic suggestion to see either a stranger in the mirror, a mirror as a window, or a mirror as a window with a view to a stranger. Participants’ deluded beliefs were challenged, and following hypnosis, Sheehan and McConkey's (1982) Experiential Analysis Technique was used to explore participants’ phenomenological experience of the delusion. Results. The majority of participants did not recognise their reflection in the mirror, described the person in the mirror as having different physical characteristics to themselves, and maintained their delusion when challenged. Conclusions. The hypnotic suggestion created a credible, compelling delusion with features strikingly similar to clinical cases of mirrored-self misidentification. Our findings suggest that Factor 2 within Langdon and Coltheart's (2000) two-factor framework may involve a lowering of the criteria used to accept or reject delusional hypotheses.

Mirrored-self misidentification: two cases of focal onset dementia

Mirrored-self misidentification: two cases of focal onset dementia

Mirrored-self Misidentification: Two Cases of Focal Onset Dementia

We present two patients in whom the mirror sign, the inability to recognize one’s own reflected image, was a stable and persisting symptom signalling the onset of a progressive dementing illness. Extensive neuropsychological testing was conducted with both patients, with particular emphasis on face processing and the understanding of reflected space. Both patients were also investigated with structural imaging techniques (computed tomography and magnetic resonance imaging). Although the neuroimaging results were not strongly lateralizing for either patient, neuropsychological testing revealed striking right hemisphere dysfunction with relatively intact left hemisphere cognitive function in both patients. Of particular interest was the patients’ dissociation on tests of face processing; one patient, FE, had significant face processing deficits while the other patient, TH, had relatively intact face processing. Further testing with TH revealed striking deficits in his ability to interpret reflected space. The results of the face processing tests are discussed in the context of current models of normal face processing, with particular emphasis on the affective component in face recognition. We propose that a combination of cognitive deficits underlie the mirror sign delusion, including perceptual, affective and reasoning impairments, and also discuss the contributions of cortical and subcortical lesions in these two patients and in delusions in general.

Mirrored-self Misidentification: Two Cases of Focal Onset Dementia

Mirrored-self Misidentification: Two Cases of Focal Onset Dementia